Group-Based Mindfulness for Patients with Chronic Low Back Pain in the Primary Care

项目摘要 OPTIME(使用正念优化医疗环境中的疼痛治疗)是一项务实的临床试验 (%)基于正念的压力减轻(MBSR)治疗慢性下腰痛(CLBP)通过 远程医疗。尽管有证据表明MBSR在减轻疼痛和改善功能方面有效，但它 仍未得到充分利用，尚未纳入常规临床护理。解决融合的障碍 在初级保健中评估MBSR并在现实生活环境中确定MBSR的有效性，我们正在进行最佳 在三个地点：新英格兰最大的安全网医院，北部联邦合格的健康中心 卡罗莱纳州和匹兹堡的一个大型学术健康中心。这些网站为大量服务不足的人提供服务 人们以及多样化的患者群体。对于最佳的成功来说，参与者必须， 诊所和相关利益攸关方充分参与该计划，并确保招聘及时和 成功。通过这一补充，我们将显著扩大患者和利益相关者的参与度，以充分 解决招聘和留用问题以及今后的传播努力。 在目标1中，我们将扩大最佳社区咨询委员会(CAB)，以包括更多的患者、临床 人员、医疗保健管理人员、倡导团体和正念组织代表。 在整个试验过程中，CAB将每月开会，成员将接受培训，以增加他们的 作为利益相关者的有效性。在目标2中，参加最佳试验的cLBP患者将被招募到 参加季度焦点小组，提供他们对改善招聘和 留存。为了增加利益相关者对参与工作提供观点的广度，我们将 采访一系列多层次的利益相关者，包括提供者、疼痛倡导团体、医疗保健 管理员和付款人。在目标3中，我们将与Story Booth(一个由通向 学习卫生系统网络)，以从没有参与研究的慢性下腰痛患者那里获得观点。 这些故事将为我们的审判活动提供信息，因为预计听到更多的声音， 包括讲西班牙语的患者，将导致确定招募的额外障碍和 实施。 我们的方法以社区为基础的参与性研究的原则为基础，以促进更大的 可持续性以及社区对最佳方案的接受程度。连续的数据分析将为迭代提供 完善协议、优化招聘、最大限度地留住员工并为未来实施做好准备的流程 和传播。

PROJECT ABSTRACT OPTIMUM (Optimizing Pain Treatment In Medical settings Using Mindfulness) is a pragmatic clinical trial (PCT) of mindfulness-based stress reduction (MBSR) for chronic low back pain (cLBP) delivered via telemedicine. Despite evidence of effectiveness for MBSR at decreasing pain and improving function, it remains underutilized and has not been embedded into routine clinical care. To address barriers to integration of MBSR in primary care and determine MBSR effectiveness in real-life settings, we are conducting OPTIMUM in three sites: the largest safety net hospital in New England, federally qualified health centers in North Carolina and a large academic health center in Pittsburgh. These sites serve large numbers of underserved people as well as a diverse patient population. For OPTIMUM to be successful it is imperative that participants, clinics, and relevant stakeholders be fully engaged in the program, and that recruitment is timely and successful. Through this supplement we will significantly expand patient and stakeholder engagement to fully address recruitment and retention issues as well as future dissemination efforts. In Aim 1, we will expand the OPTIMUM Community Advisory Board (CAB) to include more patients, clinical personnel, healthcare administrators, and advocacy group and mindfulness organization representatives.The CAB will meet monthly throughout the course of the trial, and members will receive training to increase their effectiveness as stakeholders. In Aim 2, persons with cLBP enrolled in the OPTIMUM trial will be recruited to participate in quarterly focus groups to provide their perspectives on strategies to improve recruitment and retention. To increase the breadth of stakeholders that provide perspectives on engagement efforts, we will interview a range of multi-level stakeholders, including providers, pain advocacy groups, healthcare administrators, and payors. In Aim 3 we will partner with Story Booth (a project led by the Path Towards a Learning Health System network) to obtain perspectives from persons with cLBP not participating in the study. These stories will inform our trial engagement efforts as it is expected that hearing a larger number of voices, including Spanish-speaking patients, will result in the identification of additional barriers to recruitment and implementation. Our approach is informed by principles of Community-Based Participatory Research, to promote greater sustainability as well as community acceptance of OPTIMUM. Continuous data analysis will inform an iterative process to refine protocols, optimize recruitment, maximize retention, and prepare for future implementation and dissemination.